[104-10224-10000.pdf — page 370]
# SECTION X## MILITARY SERVICE1.  ARE YOU REGISTERED FOR THE DRAFT UNDER THE UNIVERSAL MILITARY TRAINING AND SERVICE ACT OF 1940 (As amended)*YES*NO2.  SELECTIVE SERVICE CLASSIFI-    CATION3.  SELECTIVE SERVICE NO.4.  IF DEFERRED, GIVE REASON5.  LOCAL DRAFT BOARD NO. OR DESIGNATION AND ADDRESS## 2. MILITARY SERVICE RECORD1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP| CHECK (X) AS APPROPRIATE | ARMY | NAVY | MARINE CORPS | AIR FORCE | COAST GUARD | MERCHANT MARINE | NATIONAL GUARD | AIR NAT'L. GUARD | FOREIGN ORGAN. OR MIL. SERVICE (Specify) || ------------------------ | ---- | ---- | ------------ | --------- | ----------- | --------------- | -------------- | ---------------- | ---------------------------------------- || HAVE SERVED              | X    |      |              |           |             |                 |                |                  |                                          || NOW SERVING              |      |      |              |           |             |                 |                |                  |                                          |2.  BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S)3.  DATE SEPARATED FROM EXTENDED ACTIVE DUTY (Past serving)4.  TOTAL LENGTH OF EXTENDED ACTIVE DUTY IN U.S. ARMED FORCES (Past and current service)5.  DATE ENTERED ACTIVE DUTY3/Oct/1957PAST SERVICECURRENT SERVICE6.  TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY ORGANIZATION7.  RANK, GRADE OR RATEPAST SERVICE   8. SERVICE, SERIAL OR FILE NUMBER (If now serving, provide current number)CURRENT SERVICE9.  PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLEPAST SERVICECURRENT SERVICE10. SECONDARY MIL. OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLE    PAST SERVICE    CURRENT SERVICE11. BRIEF DESCRIPTION OF MILITARY DUTIES (Indicate whether applicable to past or current service)12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY| HONORABLE DISCHARGE      | X   | RETIREMENT FOR SERVICE             | UNIQUE HARDSHIPS |     || ------------------------ | --- | ---------------------------------- | ---------------- | --- || RELEASE TO INACTIVE DUTY |     | RETIREMENT FOR COMBAT DISABILITY   | OTHER:           |     || RETIREMENT FOR AGE       |     | RETIREMENT FOR PHYSICAL DISABILITY |                  |     |13. CHECK (X) COMPONENT IN WHICH YOU SERVEDREGULAR RESERVE (Including the National and Air National Guard) OTHER (Including AUS)## 3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS| 1. DO YOU NOW HAVE RESERVE STATUST | YES | 2. ARE YOU NOW A MEMBER OF THE NAT'L. GRO. OR AIR NAT'L. GRO.T | YES | 3. ARE YOU NOW A MEMBER OF THE ROTC | YES || ---------------------------------- | --- | -------------------------------------------------------------- | --- | ----------------------------------- | --- ||                                    | ✓   |                                                                | NO  |                                     | NO  |4.  IF YOU HAVE ANSWERED "YES" TO ITEMS 1, 2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW| ARMY       | MARINE CORPS    | NATIONAL GUARD | COAST GUARD!   | NAVY ROTC | INDICATE ROTC CATEGORY NUMBER || ---------- | --------------- | -------------- | -------------- | --------- | ----------------------------- ||            |                 |                |                |           |                               ||            |                 |                |                |           |                               || AIR FORCE. | AIR NAT'L.GUARD | ARMY ROTC      | AIR FORCE ROTC |           |                               |5.  CURRENT RANK, GRADE OR RATE6.  DATE OF APPOINTMENT IN CURRENT RANK7.  EXPIRATION DATE OF CURRENT RESERVE OBLIGATION....8.  CHECK (X) CURRENT RESERVE CATEGORYREADY RESERVE STANDBY(Active) STANDBY(Inactive) RETIRED9.  PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLE10. SECONDARY MILITARY OCCUPATIONAL SPECIALTY (Mos of Designator) AND TITLE11. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES12. ARE YOU CURRENTLY ASSIGNED OR ATTACHED TO A RESERVE, NAT'L. GUARD OR ROTC TRAINING UNIT*YES*NO13. IF YOU HAVE ANSWERED "YES" TO ITEM 12. GIVE UNIT OR AGENCY AND ADDRESS14. HAVE YOU A MILITARY MOBILIZATION ASSIGNMENTT    YES    NO15. IF YOU HAVE ANSWERED "YES" TO ITEM 14. GIVE UNIT OR AGENCY AND ADDRESS16. INDICATE TOTAL MILITARY SERVICE YEARS FOR LONGEVITY PURPOSES INCLUDING ACTIVE AND INACTIVE DUTYMONTHS17. WHERE ARE YOUR SERVICE RECORDS KEPTT